Director of Compliance, Marketing

POSITION SUMMARY:

 

The Director of Compliance, Marketing is responsible for the management and execution of Bravo Health’s Medicare Advantage and Part D Compliance review of marketing and member material to ensure that such material meets CMS requirements.  The purpose of this position is 1) to ensure that the company meets all contractual and regulatory obligations with respect to such material and 2) to work collaboratively with business users on the development and/or review of such material. The Director manages the review processes of such material for Compliance, performs compliance reviews of such material, manages Compliance staff that is dedicated to this function, develops training material, provides training as needed, develops and evaluates policies and procedures, and performs other functions as needed to support Bravo Health’s compliance initiatives.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 ·  Responsible for managing the approval process within Bravo Health and with CMS of all marketing and member materials, including·  Achieve and maintain a 90% or better approval rating of material reviewed by CMS·  Achieve and/or maintain “File and Use” status for Bravo Health·  Responsible for the coordination among departments regarding benefit and other information that is presented in marketing and member material

·  Responsible for developing and/or managing version control system(s) of all documents to assure that the final CMS approved version is complete and accurate and can be retrieved/access by Bravo Health·  Manage accurately all data interchanges with CMS and its software systems

·  Skilled and knowledgeable on CMS’ software application (s) for the submission of marketing and member material

·  Liaison, as needed, with CMS’s Central Office and Regional Office staff on the review and approval of marketing and member materials

·  Be able to work diplomatically with regulators

·  Be able to work diplomatically with business owners so that they understand and conform to regulatory requirements

·  Must be highly knowledgeable and skilled on CMS marketing and member material guidelines, have the ability to review such material to CMS requirements, have the ability to develop and present training on such requirements

·  Develops and maintains performance metrics and reports on the status and review of marketing and member material

·  Works with regulators and business owners to resolve compliance issues

·  Performs internal audits to ascertain compliance to CMS requirements

 EDUCATION and EXPERIENCE

 Bachelor’s degree; Masters Degree preferredMinimum 5+ years of experience in healthcare with a focus on Medicare managed care Demonstrated supervisory experienceDemonstrated capabilities in administering the review and CMS approvals of marketing and member material, including Evidence of Coverage for a Medicare Advantage plan and/or PDP.

 

 

KNOWLEDGE, SKILLS AND ABILITIES:

 Knowledge of Medicare Advantage and Medicare Part D Thorough knowledge of the CMS Marketing Guidelines and requirements for Medicare Advantage Plans and PDPs.Detailed knowledge and experience in working with “HPMS” for the submission and review of marketing and member materials

·  Demonstrated skill in developing performance metrics and internal controls

·  Demonstrable skill and experience in developing and implementing policies, procedures and practices designed to promote compliance with the requirements of the Medicare Advantage/Medicare PDP programs.

·  Skill and ability to research and interpret regulations, regulatory guidance and CMS issuances,

o Ability to communicate effectively both orally and in writing with a variety of internal and external constituents, agencies and groups.

·  Skill and demonstrable experience in assessing compliance training needs and in developing and delivering effective baseline and ongoing training for staff.

 

COMMUNICATION SKILLS:

·  Professional verbal and written communication skills

·  Ability to communicate effectively with various levels of management  and staff throughout the company

·  Ability to interact will all levels of both state and federal regulatory agencies

·  Ability to work, interact and effectively communicate within a team

 

 

 

 

 

COMPUTER SKILLS:

·  Proficiency with Microsoft Office (e.g. Word, Excel, PowerPoint, and Outlook) and other software applications

·  Proficiency with CMS’ HPMS software application(s)

·  Database software knowledge preferred

 

PROBLEM SOLVING: Demonstrated ability and experience with making sound decisions based on data availableStrong ability to identify and assess compliance risk for Medicare and related programs/products

 

PROBLEM SOLVING ABILITY:Excellent skill and ability to identify compliance risk factorsStrong conflict resolution skills

 

DECISION MAKING SKILLS:Ability to provide recommendations and make clear decisions based on established guidelinesAbility to make sound decisions on internal controls; interpret/identify compliance issues

 

SUPERVISORY SKILLS:Ability to supervise Compliance staff, including staff development and coachingAbility to provide clear guidance with interpretation on compliance issues to all levels of organization

 

PHYSICAL DEMANDS;Ability to work in a highly professional business environmentAbility to work overtime, including nights and weekends Flexible and able to travel when needed for business reasons